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Know Your Cancer Family Tree: Read Sandi's Story
When it comes to cancer, your genes play a role
Date: 11/4/2010

Read Sandi's story
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Cancer diagnosis can feel like a bolt from the blue. But the truth is, these cells can lurk undetected in your body for years. Cancer forms when one cell decides to pursue its own agenda of rapid growth at the cost of the health and well-being of surrounding tissues. But why would a normal, healthy cell trail off on such a deadly tangent? And how do you stop it?
 

DNA is Destiny

The answer lies in your DNA, the genetic blueprint that directs the actions of all the cells in your body. "Cancer arises because of the damage to your DNA," says Ethan Wasserman, MD, an oncologist who provides medical expertise for patients seeking genetic counseling at The Cancer Institute of New Jersey (CINJ) Hamilton. Once it becomes damaged, usually the cell dies or is able to repair the DNA. But in cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for the 5 to 10 percent of cancers that are inherited. It's actually more common for a person's DNA to be damaged by things in the environment: tobacco smoke, too much sunlight, viruses and chemicals.


This damage accumulates as you age, increasing the odds you'll develop cancer as you grow older. For people age 39 and younger, only one in 70 men and one in 49 women develop cancer, Dr. Wasserman says. But once people turn 70, he says the odds of developing cancer jump to one in three men and one in four women.

Genetic Testing: Is There Promise?

Pick up an old family photograph and you might discover you share grandma's button nose or grandpa's dimples. But what's not so obvious is that your genetic blueprint, or DNA, passed on by your ancestors might also carry a gene mutation that increases your risk for developing cancer.


Genetic testing is now available to detect abnormalities in our genes such as BRCA1 and BRCA2 for breast cancer. But assessments are for men and women. "We know there are markers for colon cancer which affects both men and women, and the risk of prostate cancer can be elevated with a family history of breast, ovarian or colon cancer," says Hetal Vig, CINJ genetics counselor.

"Knowing about our risk for cancer should start when we're younger. Say you are a 23-year-old woman visiting the gynecologist. When you are filling out a medical history, checking those boxes, your physician should be able to initially place you in one of four categories: high risk, increased risk, some risk or no risk."

Inherited abnormalities of these genes may explain 5 to 10 percent of breast cancer cases and 10 to 15 percent of ovarian cancer cases in the US each year, according to the American Cancer Society (ACS).

That's only a tiny fraction of the cancer conundrum. "We haven't reached the point where the average person can get a genetic test to find out if they're at risk for a certain cancer," says Wasserman, "but there's certainly promise for that in the future."

Vig agrees. "This is all about the future and the future of our children and families. For people with cancer, I encourage them to step back from all the complexities of treatment. Let us do this for you and your family now. We can take a blood sample and have this information for later. It will be so important for your loved ones."

For scientists, the search goes on for other genetic abnormalities that will help us better understand who is at greatest risk for which cancers. "At CINJ, we keep our database up-to-date and we are doing a lot of research. The answers are out there, and we will continue to seek the cure." 



  Meet Sandi of Hamilton

All her adult life, Sandi expected to hear "It's breast cancer." Her mother passed away in her 40s from breast cancer and "I was prepared," she says.  So when the day came that she learned she had ovarian cancer, that diagnosis was a surprise.  Right away, she set up her treatment plan at CINJ Hamilton. She also called her children. "That was tough.  I knew what it was like losing my mother."

When her and her mother's history in mind, her oncologist Michael Eleff, MD, recommended testing to determine her family's risk of cancer.  After the genetics counselor took her personal and family history, Sandi gave a blood sample for lab analysis. "I had the gene. They were all very gentle in delivering the news, but we all knew it.  I immediately thought of my daughter and whether she had it."

"Meanwhile, two months after my diagnosis, my daughter went in for her check up. She had been asking for a baseline mammogram, but was told it was too early and that my mother's cancer was two generations away. Now she had new information, and I flew to California to accompany her. She got her mammogram without a fight, and wouldn't you know she had early breast cancer."

More action from New Jersey followed. "They used my test results to take care of her.  She was found to have the same genetic marker."

A year later, mother and daughter are feeling well again. "We've been very lucky. I didn't know any other family history related to cancer. The genetics counselor provided me with a letter outlining the results and I hope it's useful in the future."

"I shared the news with my cousins, too. I felt morally obligated. This is tough, but I never had an issue with cancer. I had an issue with dying. And we have to do what we have to do to live and protect our families."

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